rp21 situational analysis - Pacific Health Voices

Situational analysis of drug and alcohol issues and responses in the Pacific
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interventions; and program integration
with the mental health services system. The
effectiveness of these responses in the Pacific
context has not been well evaluated and, in
contrast to countries with more developed
responses to substance use issues, the PICTs
lack clear frameworks for responding.
As a consequence of existing funding priorities
and resource allocations, government
departments and other service providers have
initiated responses to substance use issues
via HIV prevention, non-communicable diseases,
and gender and other development
programs. While this pragmatic approach
recognises the important role substance use
plays in impeding successful implementation
of development programs, the result is a series
of somewhat disjointed service and treatment
responses across a range of disciplines
with only rare opportunities for consolidation
and analysis of evidence for effective
interventions to reduce substance- related
harms in the Pacific context. Furthermore,
responses of this type, which are largely
abstinence-based approaches, raise wellfounded
concerns regarding stigmatisation
of substance use, as demonstrated in a recent
survey of mental health workers, over
80 per cent of whom felt alcohol dependence
and addiction were a result of individual
weakness or some other ‘personality flaw’.
Bias of this type extends beyond service discrimination
with a recent evaluation of the
New Zealand-funded regional employment
programs reflecting a degree of self- (and
sometimes village or district level) exclusion
of people known to consume both licit and
illicit substances from the opportunity to
participate in these schemes. Workers from
a number of countries have developed an
international ‘reputation’ for involvement in
alcohol- and other drug-related incidents
which further acts as a barrier to program
participation. Such concerns have been raised
with respect to fishing crews from Kiribati
and Tuvalu, each with the capacity to provide
many more workers than are currently
employed and each having done so in the
past, but now confronted by risk-averse employers
seeking to avoid employing staff with
substance ‘abuse’ issues. The contribution
that initiatives such as the regional seasonal
migration schemes make to the development
of small island states in particular has the
potential to be severely limited if these attitudes
prevail without responses to address
the underlying issues.
In contrast to health and development responses
in this area, there is a strong law
enforcement focus on supply reduction of
illicit drugs in the region. Pressure for legislative
and financial sector reforms and accession
to international treaties and conventions
represent the imbalance in the response.
This is paired with school-based education
programs with a demand reduction focus,
often implemented in partnership with law
enforcement.